Anticoagulant Discontinuation Death Lawsuit

Johnson v. Pham

This is wrongful death medical malpractice case filed in Baltimore County. The victim's family alleges that their wife/mother died because an internal medicine doctor took her off anticoagulant therapy for too long after surgery, causing a pulmonary embolism.

This lawsuit was filed in Maryland Health Claims Arbitration on January 5, 2017, and it is the fourth medical malpractice case filed in Maryland in 2017.

Summary of Plaintiff's Allegations

Decedent plaintiff goes to the emergency room at Northwest Hospital due to severe lower-back pain. Her back pain started earlier the same month, after a fall. The doctors treat her conservatively with pain medication. When the pain medications do not work, the doctors do a CT scan, which show that she has a vertebral compression fraction in her lumbar spine.

Due to the fracture, a surgical procedure (kyphoplasty) is scheduled for the following day. It is later discovered the surgeon is unavailable to do the procedure, so it is rescheduled for 5 days later. In the meantime, defendant doctor keeps decedent on pain medication as well as an anticoagulant, Fondaparinux, to prevent blood clots.

The day before the surgery was rescheduled for, the anticoagulant is stopped. It is supposed to be started again the day following the surgery, however, it is not restarted on that date. The surgery is postponed multiple times, but after the anticoagulant was stopped it was never restarted.

One evening while awaiting surgery, the woman's husband is helping her into the hospital bed, when she suddenly grabs her chest, her skin turns blue, and she becomes unresponsive. She dies, and an autopsy is done. The autopsy reveals that she suffered a bilateral pulmonary embolism, significant enough to block her pulmonary arteries by blood clots.

Additional Comments
  • Maryland Dental MalpracticeNo one disputes that there are times when anticoagulant therapy must be modulated before surgery. Individuals taking Coumadin who must undergo procedures that might produce some trauma are generally taken off of Coumadin for the days before the procedure to let the INR (international normalized ratio) fall from the therapeutic range of 2.0-3.0 for atrial fibrillation or 2.5-3.5 for prosthetic heart valves to <1.5. The standard of care question typically involves how much tapering and how long after surgery do you wait to reinitiate an anti-coagulate.
  • The patient had a pulmonary embolism. In a lot of these cases, the injury is a stroke, often when the victim is taking a blood thinner for atrial fibrillation. The effectiveness of anti-coagulation in preventing stroke not disputed. Guidelines for Atrial Fibrillation published by the American College of Cardiology indicate there is a greater than 80% reduction in stroke when atrial fibrillation patients used an anti-coagulate. When an atrial fibrillation patient is without a blood thinner, it allows the formation of a blood clot that may form and enter the brain and cause a stroke.
  • The defense in these cases always is that the patient wanted - or better for the doctor, needed - the surgery and bleeding is a real risk with any surgery. So the doctor is placed in a no-win situation. It is true that the surgeon needs to walk a delicate balance in deciding whether the patient is better off stopping anticoagulants and if so, for how long. There is also the question of whether the patient should switch from long-acting anticoagulants like coumadin to shorter-acting ones like heparin or Lovenox. There is jury appeal in this argument. But, ultimately, there is a standard of care doctors have to follow to properly walk this line.
Jurisdiction
  • Baltimore County
Hospitals Where Patient was Treated
  • Northwest Hospital Center, Inc.
Negligence
  • Failure to adequately assess the medical needs of decedent
  • Failing to develop, implement, and update appropriate procedures that meet the needs of patients requiring anticoagulation medication before surgery
  • Failure to restart the anticoagulant or administer low dosages
  • Failure to administer an alternative blood thinner to prevent coagulation
Specific Counts Pled
  • Wrongful Death
  • Survival Action
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